MR Enterography — Dictation, Appropriateness, and Dose for Residents

1. The MRE for Crohn’s: Active Inflammation or Fibrotic Stricture?

New consult from GI on a 22-year-old with suspected Crohn’s disease. The MR Enterography is on your list. The gastroenterologist wants to know if it’s active inflammation or a fibrostenotic stricture before they scope, and your attending expects a clear, structured report that answers that question directly — mentioning wall thickness, mural enhancement patterns, restricted diffusion, and any complications. No pressure. When I was a fellow, getting all the key features for inflammatory bowel disease into a clean, actionable impression was the goal. This is one of those studies where structure is everything, because treatment decisions depend on it. We’ve collected some high-yield tips and a solid template here, part of our work on the residents and fellows resource hub to make call a little smoother.

2. What an MR Enterography Covers and What Attendings Look For

MR Enterography (MRE) is the workhorse for evaluating inflammatory bowel disease (IBD), particularly Crohn’s disease, without using ionizing radiation. This makes it a first-line choice for younger patients who will need surveillance imaging over many years. The study uses a large volume of oral contrast to distend the small bowel loops, allowing for detailed assessment of the bowel wall, mesentery, and surrounding structures.

Your attending will expect a systematic evaluation focused on three key areas:

• Active Inflammation: Is there evidence of active disease? Look for mural thickening (>3 mm), stratified or avid mural enhancement, restricted diffusion, and the “comb sign” of engorged vasa recta in the adjacent mesentery.
• Chronic Damage & Strictures: Is there a stricture? Is it inflammatory (enhancing, restricted diffusion) or fibrostenotic (no enhancement, no restricted diffusion, fixed on CINE sequences)? Note the location, length, and degree of proximal bowel dilation.
• Penetrating Disease & Complications: Are there fistulas (enteroenteric, enterocutaneous, enterovesical), phlegmon, or abscesses? Describe their tracts and collections.

Always make a point to meticulously evaluate the terminal ileum, as it’s the most common site of involvement in Crohn’s disease.

3. Radiology Report Template for MR Enterography

This template provides a solid starting point. You can adapt it for your institution’s specific macros in PowerScribe or other dictation systems. The key is to be systematic and answer the clinical question.

Technique

Multiplanar, multisequence MRI of the abdomen and pelvis was performed before and after the administration of intravenous gadolinium-based contrast. The patient received 1.5 L of neutral oral contrast material prior to the examination for enteric opacification. An anti-peristaltic agent was administered. Sequences include T2-weighted single-shot images, balanced steady-state free precession cine imaging, diffusion-weighted imaging, and multiphasic T1-weighted fat-suppressed gradient-echo images.

Findings

COMPARISON: [Date of prior study]

BOWEL: The small bowel is evaluated from the ligament of Treitz to the terminal ileum. The terminal ileum is well-visualized and appears [normal/abnormal].

Describe findings systematically:

• Location: [e.g., Terminal ileum, distal jejunum, etc.]
• Wall Thickness: [e.g., Mild/moderate/severe mural thickening measuring up to X mm.]
• Enhancement: [e.g., Avid mural enhancement. Stratified “target sign” enhancement is present.]
• Stricture: [e.g., A Y cm long stricture is noted with associated upstream small bowel dilatation measuring up to Z cm. The stricture demonstrates avid enhancement, consistent with active inflammation / The stricture demonstrates minimal enhancement, suggestive of a fibrostenotic component.]
• DWI: [e.g., Corresponding restricted diffusion is present.]
• Cine Imaging: [e.g., The involved segment is aperistaltic on cine sequences.]
• Complications: [e.g., No evidence of fistula, abscess, or phlegmon. OR A simple enteroenteric fistula is seen between the terminal ileum and the sigmoid colon.]
• Mesentery: [e.g., Prominent vasa recta (“comb sign”) are seen adjacent to the involved segment of bowel. Several enlarged mesenteric lymph nodes are present.]

COLON: The visualized portions of the colon appear unremarkable.

SOLID ORGANS: Liver, spleen, pancreas, adrenal glands, and kidneys are unremarkable.

OTHER: No free fluid or free air. The visualized osseous structures are unremarkable.

Impression

1. Evidence of active inflammatory Crohn’s disease involving [e.g., a 10 cm segment of the terminal ileum], characterized by mural thickening, avid stratified enhancement, restricted diffusion, and an adjacent “comb sign.”

2. [e.g., A 3 cm long inflammatory stricture is present in the terminal ileum with moderate upstream small bowel dilatation.]

3. [e.g., No evidence of abscess or fistula.]

4. Free Radiology Template Sources

Building your own macro library is a rite of passage, but you don’t have to start from scratch. If this template isn’t a perfect fit, two great free repositories exist with community-vetted options for nearly every study you’ll encounter on call.

• RadReport.org: Curated by the RSNA, this is the most comprehensive library out there. It’s a fantastic resource for standardized, best-practice templates.
• Radiology Templates (AU): An excellent, well-maintained library from Australian radiologists with clean, practical templates for a wide range of modalities.

5. The Next-Level Move: AI-Assisted Structured Reporting

The real bottleneck isn’t finding a template; it’s populating it accurately and efficiently under pressure. Instead of clicking through a dozen fields in a macro, you can dictate the positive findings in free form—”There’s a 5 cm segment of thickened and enhancing terminal ileum with restricted diffusion and an adjacent comb sign”—and let an AI tool handle the rest.

This is what we’re building with GigHz Precision AI. It takes your free-form dictation of positive findings and generates a complete, structured report using vetted templates from societies like the ACR and SIR. It’s designed to streamline the reporting process, ensuring all key elements are included without the tedious manual work of navigating complex macros. For studies that require it, the appropriate Clinical Decision Support (CDS) frameworks fire automatically based on your findings.

6. When Should You Order an MR Enterography? ACR Appropriateness Criteria

Deciding between MRE and CT enterography (CTE) is a common clinical question. The American College of Radiology (ACR) provides clear guidance. For both adult and pediatric patients, MRE is consistently rated “Usually Appropriate” for the initial workup of suspected Crohn’s disease, evaluation of a suspected acute exacerbation, and for routine disease surveillance or monitoring therapy.

The key advantage of MRE is the lack of ionizing radiation, which is a critical consideration in young patients who may require multiple follow-up scans over their lifetime. Per the ACR’s “Crohn Disease” and “Crohn Disease-Child” topics, MRE is the preferred first-line modality for these indications.

When MRI is contraindicated or unavailable, CT enterography is the primary alternative. Other modalities like capsule endoscopy (for mucosal evaluation) or traditional colonoscopy with terminal ileum intubation also play important roles, but MRE provides the most comprehensive, non-invasive assessment of transmural and extra-enteric disease.

7. MR Enterography Imaging Protocol — Phases, Contrast, and Key Parameters

A successful MRE hinges on a robust protocol that maximizes bowel distention and minimizes motion artifact. This typically involves a large volume of oral contrast, an anti-peristaltic agent like glucagon, and a specific set of MRI sequences designed to highlight inflammation and assess bowel motility.

The table below outlines a standard MRE protocol. The combination of T2-weighted imaging for anatomy, diffusion-weighted imaging for cellularity (inflammation), cine sequences for motility, and multiphasic post-contrast T1-weighted imaging for enhancement patterns provides a comprehensive evaluation.

Common protocol pitfalls: The most common issues are inadequate small bowel distention from insufficient oral contrast intake and motion artifact from active peristalsis. Ensure the patient has finished the contrast and administer glucagon immediately before scanning. If motion persists, repeating key sequences can be helpful.

8. The 3-Months-Free Offer for Radiology Residents and Fellows

3+ months free for radiology residents and fellows

Look like a rockstar on your reports — dictate positive findings in free form, and our AI generates a structured report using ACR + SIR templates, with the appropriate clinical decision support firing automatically. All we ask in return is your feedback so we can keep improving the product for trainees.

The signup is simple. No credit card, no long forms. To get set up, we just need three things:

1. Your PGY year (e.g., PGY-2, PGY-4)
2. Your training type (radiology residency or specific fellowship — IR, body, MSK, neuro, peds, breast, nucs)
3. Your training program / hospital name
4. (Optional) Your institutional email

Ready to give it a try? Send us your details and apply for the residents free-access program.

9. Frequently Asked Questions about GigHz Precision AI

Is it HIPAA-compliant?

Yes. The platform is designed for de-identified workflows by default. It operates on the anonymized text of your findings, not on raw DICOM images or patient-linked EMR data. No PHI is required or stored.

Do I need my IT department to install something?

No. GigHz Precision AI is browser-based and requires no local software installation. It works on any modern web browser, including the ones on hospital workstations or your personal call-room iPad.

Does it work with PowerScribe or other dictation systems?

Yes. It works alongside your existing dictation system. You dictate as you normally would, and use the tool to quickly structure your findings and generate the impression, which you can then finalize in your PACS/RIS.

Can I use this on my phone or iPad?

Absolutely. The interface is fully responsive and designed to work on desktops, tablets, and mobile devices, making it accessible whether you’re at a workstation or on the go.

Can I customize the templates?

Yes. While the system comes pre-loaded with ACR and other society-based templates, you can create, modify, and save your own templates to match your personal or institutional preferences.

What happens after I finish residency or fellowship?

The free access program is specifically for trainees. After you graduate, you can transition to a standard plan. We offer discounts for recent graduates to help you get started in your practice.

Free GigHz Tools That Pair With This Article

Three free tools that complement the material above:

• ACR Appropriateness Criteria Lookup — Type an indication or clinical scenario in plain language and get the imaging studies the ACR rates for it, with adult and pediatric radiation levels. Built directly from 297 ACR topics, 1,336 clinical variants, and 15,823 procedure ratings.
• GigHz Imaging Protocol Library — A searchable library of 131 imaging protocols with the physics specs surfaced and the matching ACR Appropriateness Criteria alongside. Plain-English narratives readable in 60 seconds, organized by modality.
• GigHz Radiation Dose Calculator — Pick the imaging studies a patient has had and see total dose in millisieverts (mSv) with comparisons to natural background radiation, transatlantic flights, and chest X-rays. Useful for shared decision-making.

Reviewed by Pouyan Golshani, MD, Interventional Radiologist — May 7, 2026